The relation of maternal job strain and cortisol levels during early pregnancy with body composition later in the 5-year-old child: The ABCD study Aimée E. Van Dijk a, b, ⁎, Manon Van Eijsden b , Karien Stronks a , Reinoud J.B.J. Gemke c , Tanja G.M. Vrijkotte a a Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands b Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands c Department of Pediatrics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands abstract article info Article history: Received 22 March 2011 Received in revised form 23 August 2011 Accepted 12 September 2011 Keywords: Child Child, preschool Fetal development Obesity Obesity, abdominal Pregnancy Stress, psychological Workload Background: Prenatal exposure to maternal stress may program the fetal HPA axis, potentially leading to altered metabolism in later life, associated with adiposity and diabetes. Aims: This association is little studied in humans, and thus we explore whether high maternal job strain during early pregnancy, as well as maternal cortisol levels are associated with increased body mass index (BMI), cen- tral adiposity or body fat mass in the offspring at age five. Additionally, we explore whether these associations are modified by gender or mediated by gestational age and fetal growth restriction. Study design: 2939 pregnant women (ABCD cohort study) completed a questionnaire around gestational week 16 including the Job Content Questionnaire, assessing job strain. Serum total cortisol was assessed in a subsample (n= 1320). Gestational age (≥37 weeks), standardized birth weight and information on many covariates were available. At the age five health check, height, weight (BMI, kg/m 2 ), waist circumference (waist-to-height ratio, WHtR) and Fat Mass Index (FMI, kg/m 2 ) were assessed. Results: Job strain was not associated with higher BMI, WHtR or FMI. Higher maternal cortisol was independently associated with marginally higher FMI in girls, but marginally lower FMI in boys (β 0.09 and β -0.10 per 100 unit increase in serum cortisol, respectively. p b 0.01). This association was not mediated by gestational age or fetal growth restriction. Conclusions: Results show that prenatal maternal job strain and cortisol may not program obesity and adiposity in the next generation in humans, but gender differences should always be considered. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The prevalence of overweight and obesity in children has tripled over the past decades [1]. This increase may be largely attributed to decreased physical activity and increased caloric intake [2]. However, accumulating evidence from observational as well as animal studies shows that other factors, acting in early life, are probably also involved [3–6]. According to the ‘fetal programming hypothesis’, prenatal exposure to suboptimal intra-uterine conditions could predispose the individual to chronic disease at adult age [7]. Such conditions could be exposure to maternal malnutrition [8,9], but also exposure to psychosocial stress [10–14]. Stress can be defined in numerous ways, ranging from self- reported psychosocial complaints, e.g. experienced life events [15], anxiety, depression [16] and job strain [17], to physiological indicators, such as glucocorticoids [18]. Despite the increasing body of evidence from animal studies [4–6], so far there have only been two known stud- ies in humans relating prenatal maternal psychosocial stress to body composition in the offspring during childhood. The study by Li et al. however only used BMI as a measure of body composition [19], and in the study by Ertel et al., body composition was already measured at age three [20]. The present study therefore aims to examine the relation of prenatal stress exposure with the child's body composition. We chose to study job strain as the psychosocial stressor as it is highly prevalent in women of reproductive age [21], but receives less attention than, for ex- ample, depression or anxiety. Moreover, job strain can be a chronic stressor and related to altered HPA-axis activity, leading to higher mean cortisol or altered cortisol awakening responses [22]; it therefore has the potential to program the fetus' HPA-axis. As a physiological measure of stress, we also explore whether high maternal cortisol sta- tus during early pregnancy is associated with adiposity measures in the offspring at age five. Lastly we will examine sex-specific effects, given the accumulating evidence of sex-specific effects in fetal programming, with males gen- erally found to be more sensitive to stress in utero [23–26], and the mediating role of gestational age and birth weight, given the evidence Early Human Development 88 (2012) 351–356 ⁎ Corresponding author at: Department of Public Health; Postbus 22660, 1100 DD Amsterdam, The Netherlands. Tel.: + 31 20 5664786. E-mail address: a.e.vandijk@amc.uva.nl (A.E. Van Dijk). 0378-3782/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2011.09.009 Contents lists available at SciVerse ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev